Provider Demographics
NPI:1710854518
Name:GRAVES, SHONI LAVON (PMHNP)
Entity type:Individual
Prefix:
First Name:SHONI
Middle Name:LAVON
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25277 RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:JULIAETTA
Mailing Address - State:ID
Mailing Address - Zip Code:83535-6113
Mailing Address - Country:US
Mailing Address - Phone:208-816-6700
Mailing Address - Fax:
Practice Address - Street 1:25277 RIDGE LN
Practice Address - Street 2:
Practice Address - City:JULIAETTA
Practice Address - State:ID
Practice Address - Zip Code:83535-6113
Practice Address - Country:US
Practice Address - Phone:208-816-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4071685363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health